title: Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children with hypospadias repair.
abstract: OBJECTIVE
  To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with hypospadias repair.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  The Department of Paediatric Anaesthesia, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, from April to September 2006.
  
  
  METHODS
  Sixty children aged between 13-53 months coming for hypospadias repair were divided randomly into two groups A and B. A caudal block was performed immediately after induction of general anaesthesia. The patients in group A received 0.125% bupivacaine 1 ml/kg with tramadol 1 mg/kg body weight caudally. Group B patients received 0.25% bupivacaine 1 ml/kg body weight caudally. Anaesthesia was discontinued after completion of surgery. In the recovery area, ventilatory frequency and pain scores were recorded at 1 hourly interval for first 6 hours and then every 2 hours for next 6 hours postoperatively. A modified TPPPS (Toddler-Preschool Postoperative Pain Scale) was used to assess the pain. Episodes of vomiting, facial flush and pruritus were noted, if present.
  
  
  RESULTS
  The duration of analgesia was significantly prolonged in group A patients (p-value=0.001). A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group A and 6.66% in group B (p-value=0.64). No respiratory depression, flushing and pruritus were observed.
  
  
  CONCLUSIONS
  Low dose combination of bupivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects. The risk of toxicity from bupivacaine decreased when combined with tramadol in low doses.
authors.affiliation: Department of Anaesthesiology, Pakistan Institute of Medical Sciences, Islamabad. shahidkhan@yahoo.com
authors.forename: Shahid
authors.initials: S
authors.lastname: Khan
authors.forename: Mohammad Iqbal
authors.initials: MI
authors.lastname: Memon
mesh_terms: D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D006801:Humans; D007021:Hypospadias / Q000601:surgery; D007223:Infant; D008297:Male; D009294:Narcotics / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D014147:Tramadol / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D009294:Narcotics; D014147:Tramadol; D002045:Bupivacaine